To investigate the long-term progression pattern of myopic maculopathy and to determine
the visual prognosis of each progression stage.
Retrospective, observational case series.
The medical records of 806 eyes of 429 consecutive patients with high myopia (refractive
error more than -8.00 diopters [D] or axial length > or =26.5 mm) who were followed
for 5-32 years were reviewed.
Participants had complete ophthalmological examinations including best-corrected visual
acuity, axial length measurements, fluorescein angiography, and color fundus photography,
at least once a year. The presence and type of posterior staphyloma was determined
by binocular stereoscopic ophthalmoscopy. The types of myopic maculopathy included
tessellated fundus, lacquer cracks, diffuse chorioretinal atrophy, patchy chorioretinal
atrophy, choroidal neovascularization (CNV), and macular atrophy. None of the patients
had received any type of treatment for the maculopathy.
The longitudinal long-term progression pattern and the visual prognosis of each type
of fundus lesion.
During the mean follow-up of 12.7 years, 327 of the 806 highly myopic eyes (40.6%)
showed a progression of the myopic maculopathy. The most commonly observed patterns
were from tessellated fundus to the development of diffuse atrophy and lacquer cracks,
an increase in the width and progression to patchy atrophy in eyes with lacquer cracks,
an enlargement of the diffuse atrophy, and the development of patchy atrophy in eyes
with diffuse atrophy, and an enlargement and fusion of patches of atrophic areas in
eyes with patchy atrophy. Eyes with tessellated fundus, lacquer cracks, diffuse atrophy
and patchy atrophy at the initial examination progressed to the development of CNV.
Eyes with CNV developed macular atrophy. The fusion of patchy atrophy, the development
of CNV, and macular atrophy all led to significant visual decreases. A posterior staphyloma
was observed more frequently in eyes that showed progression from tessellated fundus,
diffuse atrophy, and patchy atrophy than those without a progression.
These findings indicate that myopic maculopathy tends to progress in approximately
40% of highly myopic eyes, and the pattern of progression affects the visual prognosis.
Preventive therapy targeting posterior staphyloma should be considered to prevent
the visual impairment caused by the progression of myopic maculopathy.
Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights
reserved.